Page 40 - JCBP-2-4

Journal of Clinical and
Basic Psychosomatics Core depressive symptoms of peripartum women

personal time, and shifts in the partner relationship, risk of suicidal thoughts than those with non-anxious
including sexual relationship, may be added stressors in depression. This may account for the central symptoms
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women after childbirth. Moreover, approximately 31% and higher prevalence and more severe symptoms in the
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of women with PPD have suicidal ideations. In addition postpartum period than during pregnancy in the present
to environmental risk factors, biological factors play an study. Therefore, we propose that more anxiety-centric
important role in the development of PPD. For example, interventions be administered to women with PPD and
the estrogen receptor gene is a trigger for PPD, which more depression-centric interventions be administered to
has been associated with EPDS scores in women in the women with AND. A meta-analysis reported that the effect
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postpartum period. Furthermore, although more severe of psychological therapy is highly heterogeneous, which
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depressive symptoms have been observed in women with may be attributed to the PND subtypes and their different
PPD than in those with AND, the cause remains unclear. clinical features. However, psychological therapy is
However, differences in psychotherapy effectiveness effective and should be considered the first-line treatment
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between PPD and AND have been considered as the cause for PND. Thus, identifying PND subtypes before the
for the difference in depression severity. Therefore, the implementation of targeted psychological therapy may
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differences in specific depressive symptoms between the improve the consistency of treatment efficacy.
different periods should be identified to better understand This study had several limitations that warrant
the biological mechanisms of PND subtypes. recognition. First, the participant pool was not a randomly
Consistent with a previous study’s finding, we found selected large-scale sample, and symptom data were
that most symptoms of depression have high centrality collected during a particular phase. Moreover, women in
during pregnancy. In the current study, “sadness and their first trimester were not included in this study. Thus,
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misery” and “looking forward to the future” were the the results may be applicable only to Chinese women in
most central depressive symptoms in the second trimester. their second or third trimester and those in the postpartum
However, the centrality of these symptoms decreased in period (within 6 weeks after birth). Future studies should
the third trimester and the postpartum period, indicating focus on women throughout their pregnancy as well as
that women experienced lower negative moods during during the postpartum period to explore the changes in
postpartum. Conversely, “fear and panic,” as one of the core depressive symptoms. Second, depressive symptoms
most central anxiety symptoms, exhibited the highest were not limited to the time of onset in different time
centrality in the postpartum period, indicating an increase periods. The determination of the time of onset may be
in women’s anxiety after childbirth. The depression more indicative of the core symptoms. Third, although
this study provides valuable insights into the temporal
symptoms undergo a temporal shift, transitioning from evolution of the psychological network, the analytical
depression-centric to anxiety-centric manifestations. methods employed could not reveal the underlying causal
Depression and anxiety can develop concurrently, mechanisms. Therefore, the relationships between the
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impacting 75% of women during the postpartum period. networks may be considered bi-directional due to their
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This comorbidity status may complicate the identification non-directional nature. However, examining how core
of PND subtypes because depression and anxiety share symptoms change over time in pregnant and postpartum
some biological mechanisms. Furthermore, depression Chinese women is a novelty of this study. Our study
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and anxiety are substantially associated with the genetics findings have important implications for the identification
of female reproductive system disorders. Therefore, it of PND subtypes and the selection of appropriate
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may be more accurate to focus on the individual items interventions for depression during pregnancy and the
or subscales of the EPDS, rather than the entire scale, to postpartum period.
assess PND symptoms throughout a woman’s pregnancy.
Putnam et al. reported that there are three underlying 5. Conclusion
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dimensions and five distinct clinical subtypes of PND This is the first study to examine the changes in depressive
that are measured using the EPDS, with different levels
of anxious depression being subdivided into these five core symptoms over time in pregnant and postpartum
subtypes. women. The study findings provide valuable information
for understanding the interplay between PND symptoms.
Depression with features of anxiety is characterized We identified network configurations between the second
by distinct neurobiological signatures when contrasted and third trimesters and the postpartum period, which
with depression without anxiety. Furthermore, individuals revealed a temporal progression in core symptoms
with anxious depression are more prone to recurrent from depression-centric to anxiety-centric dominance.
major depressive episodes and exhibit an elevated Therefore, to improve the mental health of mothers,

Volume 2 Issue 4 (2024) 7 doi: 10.36922/jcbp.4089